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DSHS CONTRACT NUMBER: <br />CONTRACT AMENDMENT 1563-44899 ~~W""",'."' •• 01!PAR·r.~T OF <br />Amendment No. 01 s9CJ1;~VI~:rH <br />I <br />This Contract Amendment is between the State of Washington Department of Program Contract Number <br />Social and Health Services (DSHS) and the Contractor identified below. Click here to enter text. <br />Contractor Contract Number <br />CONTRACTOR NAME CONTRACTOR doing business as (DBA) <br />Kittitas Coun ty Kitti tas County DDA Co un ty Services <br />CONTRACTOR ADDRESS WASHINGTON UN IFORM DSHS INDEX NUMB ER <br />BUSINESS IDENTIFIER (UBI) <br />507 North Nanum Street Suite 102 <br />Ellensbu rg. WA 98 926-192-002-673 1225 <br />CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS <br />Robin Read 509-962-7515 509-962-7581 ~obin.read@co.kittit~ <br />DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE <br />Developmental Disabilities Admin Division of Developmental 1769CS-63 <br />Disabilities <br />DSHS CO !'/TACT NAME AND 'r1:r LE DSHS CONTACT ADDRESs <br />Roger Van Allen 1611 W Indiana Ave <br />Operations Man~er. S pokane. WA 99205 - <br />DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS <br />(509) 329-2952 (509) 568-3037 va naJr!@ dshs,wa.gov <br />IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS <br />No <br />AMENDMENT START DATE CONTRACT END DATE <br />04/18/2016 06/30/2016 <br />PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT <br />$689,190 .00 $49,751.00 $738,941.00 <br />REASON FOR AMENDMENT ; <br />CHANGE OR CORRECT MAXIMUM CONTRACT AMOUNT <br />ATTACHMENTS. When the box below Is marked with an X , the following Exhibits are attached and are incorporated into <br />this Contract Amendment by reference: <br />181 Additional Exhibits (specify): P(ogram Agreement Budget <br />This Contract Amendment, including all Exhibits and other documents Incorporated by reference, contains all of the terms <br />and conditions agreed upon by the parties as changes to the original Contract. No other understandings or <br />representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or <br />bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing <br />below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract <br />Amendment. <br />CONT ~ nD. <br />DSHS SIGNATURE &~ /Jtjlj/~ A.lA '_ <br />DSHS Cent~ <br />6024PF Co Ir&_~.~ V-ED <br />JUL 06 2016 <br />BY: <br />PRINTED NAME AND TITLE <br />¥o ~ 1"'-' +\. Q{aL I -M~, ~j:S~ ~(~i~~ <br />PRINTED NAME AND TITLE (/$!j£:Jt Dt;SI,GNED <br />Melissa Dieberf '1ti~ -4?-I6 <br />E C E I E <br />JUN 24 2016 <br />Budget, Finance & Contracts <br />(/ <br />RECEIVED <br />JUN 1 . ~J~W <br />DDA SPOKi~NE